Provider Demographics
NPI:1992781512
Name:EICHNER, MARTIN EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:EDWARD
Last Name:EICHNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 CENTRE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3710
Mailing Address - Country:US
Mailing Address - Phone:412-661-7694
Mailing Address - Fax:
Practice Address - Street 1:2550 MOSSIDE BLVD STE 214
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3531
Practice Address - Country:US
Practice Address - Phone:412-372-4489
Practice Address - Fax:412-372-9114
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024245L204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1085998Medicaid
PA1085998Medicaid
PA137667FQPMedicare ID - Type Unspecified